Background: Previous research has shown that for many people eating disorders (ED) are not just about eating. The incidence of co-occurring personality disorders is relatively high for people in treatment for ED. Additionally, a great deal has been learned about the neurobiology of ED from neuroimaging studies. It is very likely that personality organization and brain functioning combine to impact the development, manifestation, and treatment outcomes for people with ED. In this workshop we will examine the interface of these two factors from people in residential treatment for ED and explore methods for assessing both in order to individualize treatment approaches.
Objectives:
At the conclusion of this workshop, participants will be able to:
1) List at least three references regarding the comorbidity of personality disorders and eating disorders.
2) Describe the impact of co-existing personality disorders on treatment for eating disorders
3) Discuss how changing brain electrical patterns associated with personality functioning and eating disorders can facilitate treatment outcomes.
1. Prevalence and types of personality disorders in people with eating disorders. Although actual rates of co-occurrence are not definitively known, but a variety of studies show that they are relatively common and much higher than in the general population.
2. Impact of personality disorders on treatment. Research evidence and clinical experience indicates that the coexistence of personality disorders and eating disorders can prolong and complicate the treatment process and contribute to poor outcomes.
B – Review neuroimaging research of eating disorders.
1. Neuroimaging research findings. Existing research on eating disorders has shown similarities and differences among the various eating disorders with findings implicating reward network circuitry, anxiety systems, bodily cuing networks, and sleep abnormalities.
2. Problems and limitations of existing research. With a lack of longitudinal research, it is difficult to differentiate potential pre-existing vulnerabilities from consequences of eating disorders.
C – Preliminary results of on-going research combining personality assessment with brain functioning analysis.
1. Project description. Describe the results of an on-going project assessing personality disorders and neurophysiological functioning by means of a quantitative EEG (qEEG) in a residential treatment program for eating disorders.
2. Discuss treatment implications. Evidence indicates that personality disorder factors remain after eating disorder treatment which likely indicates a vulnerability for relapse. A more thorough assessment of prevailing personality factors can contribute to individualized approaches to addressing each patient’s profile improving the probability of a long-term recovery.
D – Neurotherapy in the treatment of personality and eating disorders.
1. Use of neurofeedback in treating personality disorders. Neurofeedback has been used in the treatment of a variety of conditions ranging from epilepsy to post-traumatic stress disorder to personality disorders. It provides a noninvasive approach for improved neuromodulation.
2. Translating qEEG findings into neurofeedback protocols. Using qEEG results to identify targets for neurofeedback training can inform locations and targets for training individuals with combined personality and eating disorders.
Advancements and heightened interest in neuroimaging has led to new evidence and insights in the role of brain functioning in both eating disorders and personality disorders. There are neuroimaging indications consistent with the lack of flexibility seen in both ED and PD. Dysregulation of frontal lobe functioning, excessive engagement of the default mode network, and low levels of Alpha activity have all been associated with reduced flexibility of thinking and behavior. Neuroimaging indicators of low flexibility are common for both ED and PD. The quantitative EEG (qEEG) has proven to be a valuable approach for neuroimaging due to its relatively low cost and noninvasive technology permitting its broad use within a variety of clinical settings. Findings from qEEG studies can potentially lead to more effective treatment approaches through specifically targeted interventions.
Preliminary evidence from a current study being conducted with eating disordered patients in a residential treatment center setting is showing an even higher incidence of PD among the population. These findings are leading to using a combination of therapeutic approaches addressing the personality organization while simultaneously attempting to alter dysfunctional brain patterns through targeted neurofeedback approaches to lead to improved long-term outcomes.
Dr. Ed Hamlin is a neuropsychologist and the Clinical Director of the Institute for Applied Neuroscience. He currently holds (adjunct) faculty positions as Professor at Western Carolina University and associate professor in the Department of Psychiatry at the University of North Carolina Medical Center. In addition to clinical work, he conducts research and presents workshops regarding applied neuroscience and brain/mind relationships. His research projects involve examining the impact of early abuse and neglect on the developing brain and how to correct maladaptive patterns as well as a major collaborative research study examining dysfunctional brain patters in patients with eating disorders.
